Hormone therapy can help slow or stop cancer growth, especially if combined with other treatments. What is the success rate? Success rates vary depending on specific studies, but general research shows that hormone therapy for breast cancer helps people live longer and reduces the risk of breast cancer coming back (recurring). The analysis included 30 trials, with a total of 26,708 participants followed for 119 118 patients/years. The average duration of the trials was 4.46 years (range 0.7 to 10 years), with an average study size of 890 participants (range 52 to 16.60).
The average age of the participants at the start of the study was 62.2 ± 8.9 years in the treatment group and 63.4 ± 9.1 years in the placebo group, with an age range of 36 to 87 years. The average dropout rate was estimated at 11.5% in the treatment group and 10.6% in the placebo group. The agreement score between the evaluators on the methodological quality scores was 0.95 (95% CI), 0.6 to 1.0). Of the trials studied, 13 received a score of A, 10 received a score of B, and 7 received a score of C.
After 10 years, only men who were initially diagnosed with high-risk prostate cancer (prostate cancer with biological characteristics that predict aggressive spread) benefited from long-term treatments. Specifically, 67.2% of these men avoided subsequent increases in prostatic specific antigen (PSA), which meant a worsening of the cancer. In contrast, 53.7% of men with high-risk cancer who received four months of hormone therapy avoided similar increases in PSA. Importantly, 78.5% of high-risk men who received long-term hormone therapy were still alive after 10 years, compared to 67% of high-risk men treated with hormone therapy for four months.
These reports raise questions about which patient groups would be good candidates for primary hormone therapy. We conducted a retrospective review of the efficacy of primary hormone therapy in 628 patients with localized or locally advanced prostate cancer treated with primary hormone therapy at 7 institutions in Japan, and we tried to predict patients in whom the disease could be controlled for extended periods by primary hormone therapy (5). The overall and disease-specific survival rates at 8 years in all patients were 89.1% and 75.0%, respectively). In addition, the disease-specific survival rate at 8 years of patients treated with combined androgen blockade (CAB) was 95.3%, significantly higher than that of patients treated with castration alone. We classified patients into three risk groups based on their pre-treatment PSA level and their Gleason score, based on a modification of D'Amico's risk group (5).
The 8-year specific survival rates in the low, intermediate, and high risk groups were 97.6%, 95.4%, and 78.3%, respectively. Next, we divided low- and intermediate-risk patients into two groups with PSA levels. The study authors observed a similar effect on relapse-free survival. 81 percent of the patients in the trial relapsed, including 72 percent of those in the hormone therapy group and 91 percent of those in the group of control.
At 20 years after diagnosis, the estimated average relapse-free survival was 7.5 years in patients in the hormone therapy group and 4.7 years in the control group. The CANTO cohort analysis published in the Annals of Oncology journal will alter the general opinion about the effects that hormone therapy and chemotherapy have on the quality of life of women with breast cancer. Contrary to popular opinion, two years after diagnosis, hormone therapy, a highly effective treatment for breast cancer, worsens quality of life to a greater extent and for a longer time, especially in menopausal patients. The harmful effects of chemotherapy are more transient.
Since current international guidelines recommend prescribing hormone therapy for 5 to 10 years, it is important to offer treatment to women who have severe symptoms due to medication with hormone antagonists and to identify those who could benefit from less prolonged or intensive treatment strategies. We now have several medications (available in the form of pills, injections, and implants) that can provide men with the benefits of lowering male hormone levels without the need for irreversible surgery. Hormone therapy for prostate cancer has limitations. At this time, it is usually only used in men whose cancer has recurred or has spread to other parts of the body.
However, even in cases where it is not possible to remove or kill the cancer, hormone therapy can help slow the growth of the cancer. While not a cure, hormone therapy for prostate cancer can help men with prostate cancer feel better and add years to their lives. On average, hormone therapy can stop the cancer from progressing for two to three years. However, it varies from case to case. Some men do well with hormone therapy for much longer.
The idea that hormones have an effect on prostate cancer isn't new. The scientist Charles Huggins first established this more than 60 years ago in a work that led him to win the Nobel Prize. Huggins discovered that removing one of the body's main sources of male hormones, the testicles, could slow the growth of the disease. Huggins discovered that some types of prostate cancer cells need certain male hormones (called androgens) to grow.
Androgens are responsible for male sexual characteristics, such as facial hair, increased muscle mass and a deep voice. Testosterone is a type of androgen. Between 90 and 95% of all androgens are produced in the testes, while the rest is produced in the adrenal glands located in the upper part of the kidneys. Hormone therapy for prostate cancer works by stopping the body from producing these androgens or by blocking their effects.
Either way, hormone levels decrease and cancer growth slows. In 85 to 90% of cases of advanced prostate cancer, hormone therapy can reduce tumor size. However, hormone therapy for prostate cancer doesn't work forever. The problem is that not all cancer cells need hormones to grow. Over time, these cells that don't depend on hormones will spread.
If this happens, hormone therapy will no longer help and the doctor will need to switch to a different treatment approach. This is a summary of the techniques. However, it may be the right choice in certain cases. It's possible that some men will undergo the procedure because they're tired of getting the shots and aren't sexually active anyway, Thrasher says.
Or they may have financial problems. In the long term, an orchiectomy is much cheaper than LHRH agonists. Hormone therapy for prostate cancer can cause osteoporosis due to bone thinning, which can lead to bone fractures. However, treatment with bisphosphonates, such as Aredia, Fosamax and Zometa, can help prevent the development of this condition, Holden notes.
Unfortunately, understanding the details of hormone therapy for prostate cancer can be difficult. What drug or combination of drugs works best? In what order should they be tested? The research has not yet answered these questions. LHRH agonists remain the first common treatment. However, in some cases, doctors test antiandrogens first. Anti-androgens may be especially attractive to young men who are still sexually active, as these drugs do not completely stop sexual desire.
When antiandrogens stop working (based on prostate specific antigen tests), a person may switch to an LHRH agonist. Other doctors prefer to start therapy with a combination of two or even three medications, especially for patients with symptoms or advanced illness, Holden says. Initially, researchers expected that combined androgen blockade would significantly increase the benefits of LHRH agonists. However, the results, to date, have been mixed. Some studies have demonstrated slightly longer survival with combined androgen blockade, but the results haven't been as spectacular as many experts expected.
Other studies have shown no benefit. A possible explanation may be the type of antiandrogen used, but more studies are needed to answer this question. I think antiandrogens have made a significant difference in terms of quality of life for men with advanced prostate cancer, Brooks says. However, we haven't really seen evidence that they allow people to live longer when combined with LHRH agonists.
Experts discuss how early treatment with hormone therapy should be initiated. Some argue that the benefits of hormone therapy for prostate cancer should be offered to men at an earlier stage of the disease. Others say there's little evidence that getting treatment early is better than getting it later. However, Holden argues that early treatment can be helpful.
“I think one of the reasons the death rate from prostate cancer is dropping is because we're using hormone therapy at an early stage,” she explains to WebMD. We haven't yet demonstrated that early treatment improves overall survival, but I think we will. Researchers are also studying intermittent therapy, which involves starting and stopping hormone treatment for months at a time. The big advantage is that men can temporarily stop therapy and thus get rid of side effects. The first results of the studies have been promising.
Hormone therapy for prostate cancer is also being tested in combination with other therapies, such as radiation and chemotherapy. A recent study examined men with locally advanced prostate cancer, a cancer that has spread outside the prostate but has not yet spread to other parts of the body. The researchers found that adding just six months of hormone therapy to radiation allowed men to live longer. Researchers are also studying the effects of hormone therapy in the early stages of treatment, for example, right after or even before surgery. Some experts aren't sure how much we can improve hormone therapy for prostate cancer.
Brooks argues that prostate cancer is generally only moderately affected by hormones. You can only manipulate hormone levels to a certain extent, he says. Brooks. We need to find better ways to combat the base of cancer cells.
Thrasher and Brooks are more hopeful that future advances will be accompanied by different approaches, such as chemotherapy or vaccines. However, Holden remains optimistic about the future of hormone therapy for prostate cancer. While experts debate the best way to use hormone therapy for prostate cancer, they agree on the progress we've made in treating this illness. Improved detection and treatment, such as hormone therapy, has truly changed the landscape.
Finally, it should be noted that it is possible to eradicate death from prostate cancer, even in cases of high-risk or locally advanced prostate cancer, through the appropriate use of hormone therapy in combination with radiation therapy or radical prostatectomy. Therefore, with special attention, the possibility of using the above-mentioned drugs as second-line hormone therapy for the treatment of CRPC should be reconsidered, at least until the next generation hormonal drugs described below are available. Therefore, both doctors and patients are highly motivated to use hormone therapy only for as long as necessary. The average overall survival 20 years after diagnosis was 8.5 years for patients in the hormone therapy groups and 5.7 years for women in the control group.
In the case of HR+ breast cancer, you have cancerous tumors that rely on the hormones estrogen and progesterone to grow. Health care providers can use hormone therapy to treat prostate cancer and cancers called estrogen-dependent cancers, such as breast cancer, ovarian cancer, and uterine cancer. Surprisingly, at age 9, the cardiovascular mortality rate of men treated with adjuvant hormone therapy was 8.4%, lower than the rate of 11.4% of men without adjuvant hormone therapy. The use of hormone replacement therapy and plasma levels of sex hormones in the post-genomic cohort of Norwegian women and cancer: a cross-sectional analysis.
However, the development of the luteinizing hormone releasing hormone (LH-RH) analog allowed us to compensate for the lack of androgens in these cases, so the indications for hormone therapy have changed.
An extensive search was conducted in the Medline, Cinahl and Embase databases to identify randomized controlled trials of hormone replacement therapy between 1966 and September 2002.
Hormone replacement therapy has been shown to reduce menopausal symptoms, which affect many women with ovarian cancer. Hormone replacement therapy reduced total mortality in trials with an average age of participants under 60 years. Reproductive and hormonal risk factors for luminal, HER-2 overexpressed and triple negative postmenopausal breast cancer.However, this study doesn't answer the question of whether all intermediate-risk patients need four months of hormone therapy, and we should continue to refine our approach to address this common scenario.
